Chemico Mechanical Versus Drilling Methods Of Caries Removal- An In Vitro Study
Main Article Content
Keywords
chemico mechanical caries removal, drilling, papain gel, bromelain gel, Tree species, Children
Abstract
Context: The conventional method for caries removal is drilling with dental burs can cause anxiety and fear especially in children. Different methods of caries removal can be tried in such cases. Papain and bromelain gel being proteolytic can be used as a caries removal agent.
Aim: To evaluate the efficacy of caries removal, time taken for caries removal and surface changes using Polarized light microscopy of self-made Papain Gel and Bromelain gel with that of conventional Drilling group.
Methods and Material: Papain and Bromelain gel were self prepared in the laboratory and used as caries removal agent in the study. Fifteen permanent extracted molar teeth with class I dental caries were taken and divided into three groups randomly. Group A- Bromelain Group B- Papain Group C- Drilling. Caries removal was done, teeth restored with composite and sectioned. The teeth were mounted on slides and observed under polarized light microscopy.
Results: The time taken for caries removal using drilling method was 1.46 ± 0.1817minutes, that for bromelain gel group was 7 ± 0.695, for papain gel also it was 6.4 ± 0.56. Based on the observation made under polarized light microscopy, surface roughness and irregularities were more in Drilling group. No significant difference between papain and bromelain group was seen in time taken for caries removal.
Conclusions: There was no significant difference in the caries removal efficacy of the papain, bromelain and the drilling methods. The time taken for caries removal is more in the papain and bromelain group compared to the drilling group. However there is no significant difference between papain and bromelain. Surface irregularities and roughness is more in the drilling group compared to other groups
References
1. Osborne JW, Summitt JB. Extension for prevention: is it relevant today? Am J Dent. 1998 Aug;11(4):189–96.
2. Mathew MG, Samuel SR, Soni AJ, Roopa KB. Evaluation of adhesion of Streptococcus mutans, plaque accumulation on zirconia and stainless steel crowns, and surrounding gingival inflammation in primary molars: randomized controlled trial. Clin Oral Investig. 2020 Sep;24(9):3275–80.
3. Bussadori SK, Castro LC, Galvão AC. Papain gel: a new chemo-mechanical caries removal agent. J Clin Pediatr Dent. 2005 Winter;30(2):115–9.
4. Neves AA, Lourenço RA, Alves HD, Lopes RT, Primo LG. Caries-removal effectiveness of a papain-based chemo-mechanical agent: A quantitative micro-CT study. Scanning. 2015 Jul;37(4):258–64.
5. Poorni S, Srinivasan MR, Nivedhitha MS. Probiotic Streptococcus strains in caries prevention: A systematic review. J Conserv Dent. 2019 Mar-Apr;22(2):123–8.
6. Reddy VK, Nagar P, Reddy S, Ragulakollu R, Tirupathi SP, Ravi R, et al. Bromelain vs Papain Gel for Caries Removal in Primary Teeth. J Contemp Dent Pract. 2019 Nov 1;20(11):1345–9.
7. Poorni S, Nivedhitha MS, Srinivasan M, Balasubramaniam A. Effect of Probiotic Streptococcus salivarius K12 and M18 Lozenges on the Cariogram Parameters of Patients With High Caries Risk: A Randomised Control Trial. Cureus. 2022 Mar;14(3):e23282.
8. Venkataraghavan K, Kush A, Lakshminarayana C, Diwakar L, Ravikumar P, Patil S, et al. Chemomechanical Caries Removal: A Review & Study of an Indigen-ously Developed Agent (Carie Care (TM) Gel) In Children. J Int Oral Health. 2013 Aug;5(4):84–90.
9. de Sousa Né YG, Lima WF, Mendes PFS, Baia-da-Silva DC, Bittencourt LO, Nascimento PC, et al. Dental Caries and Salivary Oxidative Stress: Global Scientific Research Landscape. Antioxidants (Basel) [Internet]. 2023 Jan 31;12(2). Available from: http://dx.doi.org/10.3390/antiox12020330
10. Peters MC, Flamenbaum MH, Eboda NN, Feigal RJ, Inglehart MR. Chemomechanical caries removal in children: efficacy and efficiency. J Am Dent Assoc. 2006 Dec;137(12):1658–66; quiz 1729–30.
11. Biswas D, Naik Z, Kumar SL, Patil N, Bagewadi A. Efficacy of topical tulsi (Ocimum sanctum) paste for the management of oral submucous fibrosis - A clinical study. Indian J Dent Res. 2022 Apr-Jun;33(2):146–51.
12. Suresh S, Arumugham IM, Doraikannan S, Rathinavelu PK, Prabakar J, Balasubramaniam A. Comparing the Effectiveness of Herbal and Conventional Dentifrices in Reducing Dental Plaque and Gingivitis: A Systematic Review. J Int Soc Prev Community Dent. 2021 Nov 30;11(6):601–8.
13. Barma MD, Muthupandiyan I, Samuel SR, Amaechi BT. Inhibition of Streptococcus mutans, antioxidant property and cytotoxicity of novel nano-zinc oxide varnish. Arch Oral Biol. 2021 Jun;126:105132.
14. Abdul Khalek A, Elkateb MA, Abdel Aziz WE, El Tantawi M. Effect of Papacarie and Alternative Restorative Treatment on Pain Reaction during Caries Removal among Children: A Randomized Controlled Clinical Trial. J Clin Pediatr Dent. 2017;41(3):219–24.
15. Matsumoto SFB, Motta LJ, Alfaya TA, Guedes CC, Fernandes KPS, Bussadori SK. Assessment of chemomechanical removal of carious lesions using Papacarie DuoTM: randomized longitudinal clinical trial. Indian J Dent Res. 2013 Jul;24(4):488–92.
16. Gil-Montoya JA, Mateos-Palacios R, Bravo M, González-Moles MA, Pulgar R. Atraumatic restorative treatment and Carisolv use for root caries in the elderly: 2-year follow-up randomized clinical trial. Clin Oral Investig. 2014 May;18(4):1089–95.
17. Samuel SR, Acharya S, Rao JC. School Interventions-based Prevention of Early-Childhood Caries among 3-5-year-old children from very low socioeconomic status: Two-year randomized trial. J Public Health Dent. 2020 Jan;80(1):51–60.
18. Sharafeddin F, Haghbin N. Comparison of Bromelain Enzyme, Sodium Hypochlorite, and Titanium Tetrafluoride on Shear Bond Strength of Restorative Composite to Dentin: An in vitro Study. J Dent. 2019 Dec;20(4):264–70.
19. Kitsahawong K, Seminario AL, Pungchanchaikul P, Rattanacharoenthum A, Pitiphat W. Chemomechanical versus drilling methods for caries removal: an in vitro study. Braz Oral Res. 2015 Oct 20;29:1–8.
20. Santos TML, Bresciani E, Matos F de S, Camargo SEA, Hidalgo APT, Rivera LML, et al. Comparison between conventional and chemomechanical approaches for the removal of carious dentin: an in vitro study. Sci Rep. 2020 May 15;10(1):8127.
21. Corrêa FNP, Rocha R de O, Rodrigues Filho LE, Muench A, Rodrigues CRMD. Chemical versus conventional caries removal techniques in primary teeth: a microhardness study. J Clin Pediatr Dent. 2007 Spring;31(3):187–92.
22. Goyal PA, Kumari R, Kannan VP, Madhu S. Efficacy and tolerance of papain gel with conventional drilling method: a clinico-microbiological study. J Clin Pediatr Dent. 2015 Winter;39(2):109–12.
23. Ghensi P, Cucchi A, Creminelli L, Tomasi C, Zavan B, Maiorana C. Effect of Oral Administration of Bromelain on Postoperative Discomfort After Third Molar Surgery. J Craniofac Surg. 2017 Mar;28(2):e191–7.
24. Patil PA, Ankola AV, Hebbal MI, Patil AC. Comparison of effectiveness of abrasive and enzymatic action of whitening toothpastes in removal of extrinsic stains - a clinical trial. Int J Dent Hyg. 2015 Feb;13(1):25–9.
25. Chauhan K, Basavanna RS, Shivanna V. Effect of bromelain enzyme for dentin deproteinization on bond strength of adhesive system. J Conserv Dent. 2015 Sep;18(5):360–3.
26. Khatib MS, Devarasanahalli SV, Aswathanarayana RM, Venkateswara AH, Nadig RR. Microtensile Bond Strength of Composite Resin Following the Use of Bromelain and Papain as Deproteinizing Agents on Etched Dentin: An In Vitro Study. Int J Clin Pediatr Dent. 2020 Jan;13(1):43–7.
27. Oldenbourg R. Polarized Light Microscopy: Principles and Practice [Internet]. Vol. 2013, Cold Spring Harbor Protocols. 2013. p. db.top078600 – pdb.top078600. Available from: http://dx.doi.org/10.1101/pdb.top078600
28. Nandakumar M, Nasim I. Comparative evaluation of grape seed and cranberry extracts in preventing enamel erosion: An optical emission spectrometric analysis. J Conserv Dent. 2018 Sep-Oct;21(5):516–20.
29. Aparna J, Maiti S, Jessy P. Polyether ether ketone - As an alternative biomaterial for Metal Richmond crown-3-dimensional finite element analysis. J Conserv Dent. 2021 Nov-Dec;24(6):553–7.
30. Fure S, Lingström P, Birkhed D. Evaluation of Carisolv for the chemo-mechanical removal of primary root caries in vivo. Caries Res. 2000 May;34(3):275–80.
31. Malli Sureshbabu N, Selvarasu K, V JK, Nandakumar M, Selvam D. Concentrated Growth Factors as an Ingenious Biomaterial in Regeneration of Bony Defects after Periapical Surgery: A Report of Two Cases. Case Rep Dent. 2019 Jan 22;2019:7046203.
32. Ahad M, Gheena S. Awareness, attitude and knowledge about evidence based dentistry among the dental practitioner in Chennai city. J Adv Pharm Technol Res. 2016;9(11):1863. 33. PradeepKumar AR, Shemesh H, Jothilatha S, Vijayabharathi R, Jayalakshmi S, Kishen A. Diagnosis of Vertical Root Fractures in Restored Endodontically Treated Teeth: A Time-dependent Retrospective Cohort Study. J Endod. 2016 Aug;42(8):1175–80.
34. Jangid K, Alexander AJ, Jayakumar ND, Varghese S, Ramani P. Ankyloglossia with cleft lip: A rare case report. J Indian Soc Periodontol. 2015 Nov;19(6):690–3.
35. Kumar A, Sherlin HJ, Ramani P, Natesan A, Premkumar P. Expression of CD 68, CD 45 and human leukocyte antigen-DR in central and peripheral giant cell granuloma, giant cell tumor of long bones, and tuberculous granuloma: An immunohistochemical study. Indian J Dent Res. 2015 May;26(3):295–303.
36. Manohar J, Abilasha R. A Study on the Knowledge of Causes and Prevalance of Pigmentation of Gingiva among Dental Students [Internet]. Vol. 10, Indian Journal of Public Health Research & Development. 2019. p. 95. Available from: http://dx.doi.org/10.5958/0976-5506.2019.01859.x
37. Sekar D, Mani P, Biruntha M, Sivagurunathan P, Karthigeyan M. Dissecting the functional role of microRNA 21 in osteosarcoma. Cancer Gene Ther. 2019 Jul;26(7-8):179–82.
38. Girija SA, Jayaseelan VP, Arumugam P. Prevalence of VIM- and GIM-producing Acinetobacter baumannii from patients with severe urinary tract infection. Acta Microbiol Immunol Hung. 2018 Dec 1;65(4):539–50.
39. Maheswari TNU, Venugopal A, Sureshbabu NM, Ramani P. Salivary micro RNA as a potential biomarker in oral potentially malignant disorders: A systematic review. Ci Ji Yi Xue Za Zhi. 2018 Apr;30(2):55–60.
40. Subashri A, Maheshwari TNU. Knowledge and attitude of oral hygiene practice among dental students. J Adv Pharm Technol Res. 2016;9(11):1840.
2. Mathew MG, Samuel SR, Soni AJ, Roopa KB. Evaluation of adhesion of Streptococcus mutans, plaque accumulation on zirconia and stainless steel crowns, and surrounding gingival inflammation in primary molars: randomized controlled trial. Clin Oral Investig. 2020 Sep;24(9):3275–80.
3. Bussadori SK, Castro LC, Galvão AC. Papain gel: a new chemo-mechanical caries removal agent. J Clin Pediatr Dent. 2005 Winter;30(2):115–9.
4. Neves AA, Lourenço RA, Alves HD, Lopes RT, Primo LG. Caries-removal effectiveness of a papain-based chemo-mechanical agent: A quantitative micro-CT study. Scanning. 2015 Jul;37(4):258–64.
5. Poorni S, Srinivasan MR, Nivedhitha MS. Probiotic Streptococcus strains in caries prevention: A systematic review. J Conserv Dent. 2019 Mar-Apr;22(2):123–8.
6. Reddy VK, Nagar P, Reddy S, Ragulakollu R, Tirupathi SP, Ravi R, et al. Bromelain vs Papain Gel for Caries Removal in Primary Teeth. J Contemp Dent Pract. 2019 Nov 1;20(11):1345–9.
7. Poorni S, Nivedhitha MS, Srinivasan M, Balasubramaniam A. Effect of Probiotic Streptococcus salivarius K12 and M18 Lozenges on the Cariogram Parameters of Patients With High Caries Risk: A Randomised Control Trial. Cureus. 2022 Mar;14(3):e23282.
8. Venkataraghavan K, Kush A, Lakshminarayana C, Diwakar L, Ravikumar P, Patil S, et al. Chemomechanical Caries Removal: A Review & Study of an Indigen-ously Developed Agent (Carie Care (TM) Gel) In Children. J Int Oral Health. 2013 Aug;5(4):84–90.
9. de Sousa Né YG, Lima WF, Mendes PFS, Baia-da-Silva DC, Bittencourt LO, Nascimento PC, et al. Dental Caries and Salivary Oxidative Stress: Global Scientific Research Landscape. Antioxidants (Basel) [Internet]. 2023 Jan 31;12(2). Available from: http://dx.doi.org/10.3390/antiox12020330
10. Peters MC, Flamenbaum MH, Eboda NN, Feigal RJ, Inglehart MR. Chemomechanical caries removal in children: efficacy and efficiency. J Am Dent Assoc. 2006 Dec;137(12):1658–66; quiz 1729–30.
11. Biswas D, Naik Z, Kumar SL, Patil N, Bagewadi A. Efficacy of topical tulsi (Ocimum sanctum) paste for the management of oral submucous fibrosis - A clinical study. Indian J Dent Res. 2022 Apr-Jun;33(2):146–51.
12. Suresh S, Arumugham IM, Doraikannan S, Rathinavelu PK, Prabakar J, Balasubramaniam A. Comparing the Effectiveness of Herbal and Conventional Dentifrices in Reducing Dental Plaque and Gingivitis: A Systematic Review. J Int Soc Prev Community Dent. 2021 Nov 30;11(6):601–8.
13. Barma MD, Muthupandiyan I, Samuel SR, Amaechi BT. Inhibition of Streptococcus mutans, antioxidant property and cytotoxicity of novel nano-zinc oxide varnish. Arch Oral Biol. 2021 Jun;126:105132.
14. Abdul Khalek A, Elkateb MA, Abdel Aziz WE, El Tantawi M. Effect of Papacarie and Alternative Restorative Treatment on Pain Reaction during Caries Removal among Children: A Randomized Controlled Clinical Trial. J Clin Pediatr Dent. 2017;41(3):219–24.
15. Matsumoto SFB, Motta LJ, Alfaya TA, Guedes CC, Fernandes KPS, Bussadori SK. Assessment of chemomechanical removal of carious lesions using Papacarie DuoTM: randomized longitudinal clinical trial. Indian J Dent Res. 2013 Jul;24(4):488–92.
16. Gil-Montoya JA, Mateos-Palacios R, Bravo M, González-Moles MA, Pulgar R. Atraumatic restorative treatment and Carisolv use for root caries in the elderly: 2-year follow-up randomized clinical trial. Clin Oral Investig. 2014 May;18(4):1089–95.
17. Samuel SR, Acharya S, Rao JC. School Interventions-based Prevention of Early-Childhood Caries among 3-5-year-old children from very low socioeconomic status: Two-year randomized trial. J Public Health Dent. 2020 Jan;80(1):51–60.
18. Sharafeddin F, Haghbin N. Comparison of Bromelain Enzyme, Sodium Hypochlorite, and Titanium Tetrafluoride on Shear Bond Strength of Restorative Composite to Dentin: An in vitro Study. J Dent. 2019 Dec;20(4):264–70.
19. Kitsahawong K, Seminario AL, Pungchanchaikul P, Rattanacharoenthum A, Pitiphat W. Chemomechanical versus drilling methods for caries removal: an in vitro study. Braz Oral Res. 2015 Oct 20;29:1–8.
20. Santos TML, Bresciani E, Matos F de S, Camargo SEA, Hidalgo APT, Rivera LML, et al. Comparison between conventional and chemomechanical approaches for the removal of carious dentin: an in vitro study. Sci Rep. 2020 May 15;10(1):8127.
21. Corrêa FNP, Rocha R de O, Rodrigues Filho LE, Muench A, Rodrigues CRMD. Chemical versus conventional caries removal techniques in primary teeth: a microhardness study. J Clin Pediatr Dent. 2007 Spring;31(3):187–92.
22. Goyal PA, Kumari R, Kannan VP, Madhu S. Efficacy and tolerance of papain gel with conventional drilling method: a clinico-microbiological study. J Clin Pediatr Dent. 2015 Winter;39(2):109–12.
23. Ghensi P, Cucchi A, Creminelli L, Tomasi C, Zavan B, Maiorana C. Effect of Oral Administration of Bromelain on Postoperative Discomfort After Third Molar Surgery. J Craniofac Surg. 2017 Mar;28(2):e191–7.
24. Patil PA, Ankola AV, Hebbal MI, Patil AC. Comparison of effectiveness of abrasive and enzymatic action of whitening toothpastes in removal of extrinsic stains - a clinical trial. Int J Dent Hyg. 2015 Feb;13(1):25–9.
25. Chauhan K, Basavanna RS, Shivanna V. Effect of bromelain enzyme for dentin deproteinization on bond strength of adhesive system. J Conserv Dent. 2015 Sep;18(5):360–3.
26. Khatib MS, Devarasanahalli SV, Aswathanarayana RM, Venkateswara AH, Nadig RR. Microtensile Bond Strength of Composite Resin Following the Use of Bromelain and Papain as Deproteinizing Agents on Etched Dentin: An In Vitro Study. Int J Clin Pediatr Dent. 2020 Jan;13(1):43–7.
27. Oldenbourg R. Polarized Light Microscopy: Principles and Practice [Internet]. Vol. 2013, Cold Spring Harbor Protocols. 2013. p. db.top078600 – pdb.top078600. Available from: http://dx.doi.org/10.1101/pdb.top078600
28. Nandakumar M, Nasim I. Comparative evaluation of grape seed and cranberry extracts in preventing enamel erosion: An optical emission spectrometric analysis. J Conserv Dent. 2018 Sep-Oct;21(5):516–20.
29. Aparna J, Maiti S, Jessy P. Polyether ether ketone - As an alternative biomaterial for Metal Richmond crown-3-dimensional finite element analysis. J Conserv Dent. 2021 Nov-Dec;24(6):553–7.
30. Fure S, Lingström P, Birkhed D. Evaluation of Carisolv for the chemo-mechanical removal of primary root caries in vivo. Caries Res. 2000 May;34(3):275–80.
31. Malli Sureshbabu N, Selvarasu K, V JK, Nandakumar M, Selvam D. Concentrated Growth Factors as an Ingenious Biomaterial in Regeneration of Bony Defects after Periapical Surgery: A Report of Two Cases. Case Rep Dent. 2019 Jan 22;2019:7046203.
32. Ahad M, Gheena S. Awareness, attitude and knowledge about evidence based dentistry among the dental practitioner in Chennai city. J Adv Pharm Technol Res. 2016;9(11):1863. 33. PradeepKumar AR, Shemesh H, Jothilatha S, Vijayabharathi R, Jayalakshmi S, Kishen A. Diagnosis of Vertical Root Fractures in Restored Endodontically Treated Teeth: A Time-dependent Retrospective Cohort Study. J Endod. 2016 Aug;42(8):1175–80.
34. Jangid K, Alexander AJ, Jayakumar ND, Varghese S, Ramani P. Ankyloglossia with cleft lip: A rare case report. J Indian Soc Periodontol. 2015 Nov;19(6):690–3.
35. Kumar A, Sherlin HJ, Ramani P, Natesan A, Premkumar P. Expression of CD 68, CD 45 and human leukocyte antigen-DR in central and peripheral giant cell granuloma, giant cell tumor of long bones, and tuberculous granuloma: An immunohistochemical study. Indian J Dent Res. 2015 May;26(3):295–303.
36. Manohar J, Abilasha R. A Study on the Knowledge of Causes and Prevalance of Pigmentation of Gingiva among Dental Students [Internet]. Vol. 10, Indian Journal of Public Health Research & Development. 2019. p. 95. Available from: http://dx.doi.org/10.5958/0976-5506.2019.01859.x
37. Sekar D, Mani P, Biruntha M, Sivagurunathan P, Karthigeyan M. Dissecting the functional role of microRNA 21 in osteosarcoma. Cancer Gene Ther. 2019 Jul;26(7-8):179–82.
38. Girija SA, Jayaseelan VP, Arumugam P. Prevalence of VIM- and GIM-producing Acinetobacter baumannii from patients with severe urinary tract infection. Acta Microbiol Immunol Hung. 2018 Dec 1;65(4):539–50.
39. Maheswari TNU, Venugopal A, Sureshbabu NM, Ramani P. Salivary micro RNA as a potential biomarker in oral potentially malignant disorders: A systematic review. Ci Ji Yi Xue Za Zhi. 2018 Apr;30(2):55–60.
40. Subashri A, Maheshwari TNU. Knowledge and attitude of oral hygiene practice among dental students. J Adv Pharm Technol Res. 2016;9(11):1840.
Article Sidebar
Published
Jun 6, 2023
Article Details
How to Cite
S B Divya, S.Delphine Priscilla Antony S, M.S.Nivedhitha, & S Rajeshkumar. (2023). Chemico Mechanical Versus Drilling Methods Of Caries Removal- An In Vitro Study. Journal of Population Therapeutics and Clinical Pharmacology, 30(14), 49-57. https://doi.org/10.47750/jptcp.2023.30.14.007
Section
Articles
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
S B Divya, S.Delphine Priscilla Antony S, M.S.Nivedhitha, & S Rajeshkumar. (2023). Chemico Mechanical Versus Drilling Methods Of Caries Removal- An In Vitro Study. Journal of Population Therapeutics and Clinical Pharmacology, 30(14), 49-57. https://doi.org/10.47750/jptcp.2023.30.14.007